A Clinicohysteroscopic Scoring System of Intrauterine Adhesions

Abstract

We propose a new scoring system for intrauterine adhesions (IUA) that may predict the prognosis after hysteroscopic adhesiolysis. We analyzed hysteroscopic findings and clinical data of patients diagnosed as having IUA by reviewing previously published hysteroscopic classifications of IUA. The data were subjected to evaluation according to the most popular classifications in addition to the proposed classification using a scoring system for different parameters. The results obtained by the proposed scoring system matched well with other classifications regarding grade I and III IUA. But in the cases with moderate IUA (grade II), there was overlap between the classifications (sensitivity 58.3%) which can be attributed to considering the menstrual and reproductive history. Further studies are needed to assess its prognostic value.

Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes

“…Other classifications include those of March et al (16), the European Society of Human Reproduction and Endocrinology (ESHRE) (17), Donnez and Nisolle (18), and Nasr et al (19). In the current study, the severity of Asherman's syndrome was classified according to the AFS stages (13), which combine the extent of adhesions with the density of adhesions and the effect on menstrual function (Table 1).…”

Intra-uterine adhesions and fertility outcome: how to optimize success?

“…Although more complicated, this classification system takes into consideration the amount of functioning residual endometrium, and therefore may have additional prognostic value with respect to fertility outcome. The recently proposed classification system of Nasr et al [37] also includes obstetric history, as prior pregnancies, including those that end in abortion, may have positive prognostic value [11 ,38]. Many other classification systems have been set forth for Asherman's syndrome [39][40][41], and there is no clear consensus on the one to use.…”

Septums and Synechiae: Approaches to Surgical Correction

“…Accurate classification of IUA is important for subsequent evaluation of prognosis and treatment results, particularly with regard to reproductive outcome. Numerous classifications have been proposed subsequent to that of March et al, 78,[88][89][90] and all are largely based on hysteroscopic findings and parameters that include the location, appearance, and extent of the adhesions. The European Society for Hysteroscopy classification is shown in Table 3.…”